Generalised anxiety disorder
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Generalised anxiety disorder

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Generalised anxiety disorder Generalised anxiety disorder Presentation Transcript

  • GENERALIZED ANXIETYGENERALIZED ANXIETY DISORDERDISORDER KEALEBOGA D. SMITHKEALEBOGA D. SMITH MBBS IVMBBS IV
  • OBJECTIVESOBJECTIVES 1.1. Overview of GADOverview of GAD 2.2. Etiology & pathophysiologyEtiology & pathophysiology 3.3. Risk factors of GADRisk factors of GAD 4.4. EpidemiologyEpidemiology 5.5. Diagnosis (DSM-V criteria)Diagnosis (DSM-V criteria) 6.6. ComorbiditiesComorbidities 7.7. Course & prognosisCourse & prognosis 8.8. Differential diagnosesDifferential diagnoses 9.9. ManagementManagement 10.10. ReferencesReferences
  • Overview of GADOverview of GAD  Anxiety that is generalized and persistent but not restricted to, or even strongly predominating in, any particular environmental circumstances (i.e. it is "free-floating").  The dominant symptoms are variable but include complaints of persistent nervousness, trembling, muscular tensions, sweating, lightheadedness, palpitations, dizziness, and epigastric discomfort. 
  •  excessive anxiety and worry (apprehensiveexcessive anxiety and worry (apprehensive expectation) are the essential features of GADexpectation) are the essential features of GAD  The intensity, duration, or frequency of theThe intensity, duration, or frequency of the anxiety and worry is out of proportion to theanxiety and worry is out of proportion to the actual likelihood or impact of the anticipatedactual likelihood or impact of the anticipated event.event.
  • Etiology and pathophysiologyEtiology and pathophysiology  Psychobiology of GAD not well understoodPsychobiology of GAD not well understood  But there is evidence that serotonergic, GABA-But there is evidence that serotonergic, GABA- ergic & noradrenergic neurotransmitter systemsergic & noradrenergic neurotransmitter systems play a roleplay a role  GAD also involves a genetic componentGAD also involves a genetic component  Negative life events may increase the likelihoodNegative life events may increase the likelihood of the d/oof the d/o
  • Risk factors of GADRisk factors of GAD  FHx of the GADFHx of the GAD  Being a femaleBeing a female  An increase in stressAn increase in stress  Personality disorders e.g Boarderline PD linked toPersonality disorders e.g Boarderline PD linked to GADGAD  Hx of physical or emotional traumaHx of physical or emotional trauma  The risk of GAD in adolescent smokers is 5-6The risk of GAD in adolescent smokers is 5-6 times the risk among in non-smokerstimes the risk among in non-smokers  Medical illnessed associated with anxiety. E.gMedical illnessed associated with anxiety. E.g GAD occurs in 14% of patients with DMGAD occurs in 14% of patients with DM
  • EpidemiologyEpidemiology  GAD has a lifetime prevalence of 5%GAD has a lifetime prevalence of 5%  Individuals of European descent tend toIndividuals of European descent tend to experience GAD more frequently than doexperience GAD more frequently than do individuals of non-European descent (i.e., Asian,individuals of non-European descent (i.e., Asian, African, Native American and Pacific Islander).African, Native American and Pacific Islander).  Median onset=30 years but large rangeMedian onset=30 years but large range  F>M 2:1F>M 2:1
  • Diagnosis (DSM-V criteria)Diagnosis (DSM-V criteria)
  • ICD-10ICD-10 Atleast 4 symptoms (with atleast 1 from ‘autonomic arousal’) out of:Atleast 4 symptoms (with atleast 1 from ‘autonomic arousal’) out of: Autonomic arousal: palpitations; sweating; trembling; dry mouthAutonomic arousal: palpitations; sweating; trembling; dry mouth ‘‘physical’ symptoms: difficulty breathing; choking sensations; chestphysical’ symptoms: difficulty breathing; choking sensations; chest pains; nausea/abdominal distresspains; nausea/abdominal distress Mental state symptoms: dizziness; faint;Mental state symptoms: dizziness; faint; derealization/depersonalization; fear of losing control or dyingderealization/depersonalization; fear of losing control or dying General symptoms: hot flushes; chils; numbnessGeneral symptoms: hot flushes; chils; numbness Symptoms of tension: muscle tension; inability to relax; feelingSymptoms of tension: muscle tension; inability to relax; feeling keyed up or mentally tense; a sensation of lump in the throatkeyed up or mentally tense; a sensation of lump in the throat Other: exaggerated responses to minor surprisesOther: exaggerated responses to minor surprises Concentration difficulties/ ‘mind going blank’-due to worry orConcentration difficulties/ ‘mind going blank’-due to worry or anxiety; persistent irritability; difficulty getting to sleep due toanxiety; persistent irritability; difficulty getting to sleep due to worryingworrying Symptoms present most days for atleast 6 monthsSymptoms present most days for atleast 6 months
  •  but the sufferer must not meet the full criteriabut the sufferer must not meet the full criteria for depressive episode (F32.-), phobic anxietyfor depressive episode (F32.-), phobic anxiety disorder (F40.-), panic disorder (F41.0), ordisorder (F40.-), panic disorder (F41.0), or obsessive-compulsive disorder (F42.-)obsessive-compulsive disorder (F42.-)  Not explained by any medical condition orNot explained by any medical condition or psychoactive –related disorderpsychoactive –related disorder
  • NB!NB! Only one item is required inOnly one item is required in children (not 3 like in adults).children (not 3 like in adults).
  • ComorbiditiesComorbidities  Major depression most common. In abt 60% ofMajor depression most common. In abt 60% of pts with GADpts with GAD  Other anxiety d/o (simple phobias, socialOther anxiety d/o (simple phobias, social phobia, panic d/o)phobia, panic d/o)  Alcohol & drug problemsAlcohol & drug problems  Other “physical” conditions e.g IBS, atypicalOther “physical” conditions e.g IBS, atypical chest painchest pain
  • Course and prognosisCourse and prognosis  Chronic & disablingChronic & disabling  Prognosis generally poorPrognosis generally poor  Remission rates low (~30% after 3 yrs, with tx);Remission rates low (~30% after 3 yrs, with tx);  Comorbidity worsens the prognosis (esp.Comorbidity worsens the prognosis (esp. alcohol misuse)alcohol misuse)
  • Differential diagnosesDifferential diagnoses  ‘‘normal worries’normal worries’  DepressionDepression  Mixed anxiety/depressionMixed anxiety/depression  Other anxiety disordersOther anxiety disorders  Drug & alcohol problemDrug & alcohol problem  Medical conditions: e.g arrhythmias, cardiacMedical conditions: e.g arrhythmias, cardiac failure, asthma, COPD, temporal lobe epilepsy,failure, asthma, COPD, temporal lobe epilepsy, hyperthyroidism, hypoglycemia, anaemiahyperthyroidism, hypoglycemia, anaemia
  • ManagementManagement  Psychological: generally less effective than inPsychological: generally less effective than in other anxiety d/os, CBT combining behavioralother anxiety d/os, CBT combining behavioral methods (e.g relaxation techniques)methods (e.g relaxation techniques)  Pharmacological:Pharmacological: 1. Psychic symptoms-buspirone1. Psychic symptoms-buspirone 2. Somatic symptoms-BDZs2. Somatic symptoms-BDZs 3. Depressive symptoms-TCAs, SSRIs, SNRIs &3. Depressive symptoms-TCAs, SSRIs, SNRIs & 4. CVS symptoms-Beta-blockers4. CVS symptoms-Beta-blockers
  • ReferencesReferences 1.1. Textbook of Psychiatry for Southern Africa.Textbook of Psychiatry for Southern Africa. Pg148-149Pg148-149 2.2. Essentials of Psychiatry. (2006). Chapter 53Essentials of Psychiatry. (2006). Chapter 53 3.3. Toronto notes. (2011). Anxiety disordersToronto notes. (2011). Anxiety disorders 4.4. DSM-V & ICD-10DSM-V & ICD-10 5.5. Fricchione, G. Generalized Anxiety Disorder.Fricchione, G. Generalized Anxiety Disorder. NEJM, 2004. 351;7NEJM, 2004. 351;7